HomeMy WebLinkAboutMiscellaneous - 37 ANNE ROAD 11/30/2015 (2) MERRIMACK ENGINEERING SERVICES, INC,
PROFESSIONAL ENGINEERS • LAND SURVEYORS 0 PLANNERS
66 PARK STREET•ANDOVER,MASSACHUSETTS 01810•TEL(978)475-3555,373-5721 •FAX(978)475-1448•E-MAIL:merreng @ooLcom
TO: North Andover Board of Health
FROM: Bill Dufresne/Merrimack Engineering
DATE: -,71e
RE: comer. r"
TM:
TL: �.
OWNER(NAME & ADDRESS) LA0 KA
r
Members of the Board:
An upgrade sewage disposal system plan dated: n`W � has been
submitted for the above referenced site. Pursuant to Title 5, and the North Andover
Board of Health Regulations, Local upgrade approval and/or variances are being sought
from the following sections.
2)
3)
Please consider these requests for approval on your earliest available meeting agenda.
We respectfully request your consideration of these matters.
Very truly yours,
MERRIMACK ENGINEERING SERVICES
William Dufresne
cd
A
COMMONWEALTH OF MASSACHUSETTS
f p UJI EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY SM ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL
PART A
CERTIFICATION
Property Address: 3`l A M IJ E
8
C2
Owner's Name: 'jealt1n
Owner's Address:
Date of Inspection: _ D/
Name of Inspector:(please print) g,�ar-s,gN�Iry C- C-roa '7 `3 a-
Company Name: N W G-
Mailing Address:_f ca' 9 E r-t-lW 0C>n D QtU E
Telephone Number:4Za vv —12&9
CERTIFICATION STATEMENT
I certify that Thave personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my
training and etperience in the proper,function and maintenance of on site sewage.disposal systems.I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000 The system:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: Date: _&// 1 or
The system inspector shall submit a copy,of this insp ion report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall-submit the report to the appropriate regional office of the
DEP.The original should be sent to the system owner and copies,sent to the buyer, if applicable,and the approving
authority.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that,
time.This inspection does not address how the system will perform in the future,,mnderAesamcor""dim 6nt
conditions of use.
age`2.of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 3 7 A w mg �Q
Owner:
n NO ' j A&J AcNJ4/7
t...0 t tL w OGG'tt o�
Date of Inspection: a
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
Ar System Passes:
I have not found any information which indicates that any of the failure criteria d ibed in 310 CMR
15.303 in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below
Comments:
B. System Conditionally sses:
One or more system comp ents as described in the"Conditi al Pass"section need to be replaced or
repaired.The system,upon complete of the replacement or„ .., eP rep ' ,as approved by the Board of Health,will pass. `
Answer yes,no or not determined(Y,N,ND ' the fo a following statements.If`Snot determined"please
explain.
The septic tank is metal and over 20 years of or the septic tank(whether metal or not)is structurally
unsound,exhibits substantial irifiltr4hon,or exfil ion tank failure is imminent.System will pass inspection if the
existing tank is replaced with a complying Sept' tank as a roved by the Board of Health.
*A metal septic tank will pass inspection if i s structurally und,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 y old is available.
ND explain:
Observation,of sewage b p or break out or high static water 1 el in the distribution box due to broken or;
obstructed pipe(s)or due to a oken,settled or uneven distribution box. S tem will pass inspection if(with
approval of Board of Heal :
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
system required pumping more than 4 times a year due to broken or obstructed p' c(s).The system will
pass in ection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
Page 1of 11
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OFFICIAL INSPECTION FO -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued) t
Property Address: 37 A&,N 4- 2
1.\3Q=:f AaJ P®+j{rt-
Owner:
Date of Inspection: Co I 1!j of
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to�efermine if the system
is fa' ing to protect public health,safety or the environment. ;
1. stem will pass unless Board of Health determines in accordance with .0 CMR 15.303(1)(b)that the
sys in is not functioning in a manner which will protect public healt ,safety and the environment:
_ C ool or privy is within 50 feet of a surface water
Cess of or privy is within 50 feet of a bordering vegetated v/etland or a salt marsh
2. Systero,will fail unless.the card of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manne hat protects�the public health,safety and environment:
The system has aseptic tank awn
oi,Yabsorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to aass ce water supply.
The system has aseptic ta#and SAS an e SAS is within a Zone 1 of a public water supply.
_ The system has a septi tank and SAS an d the S,is within 50 feet of a private water supply well.
The system has eptic tank and SAS and the SAS is than 100 feet but 50 feet or more from a
private water sup p well".Method used to determine di
"This syste passes if the well water analysis,performed at a D certified laboratory,for coliform
bacteria volatile organic compounds indicates that the well is free om pollution from that facility and
the pr nce of ammonia nitrogen and nitrate nitrogen is equal to or less an 5 ppm,provided that no other
failure criteria are triggered.A copy of the analysis must be attached to this rm.
3. Other:
Page 4 of 11 '
d
OFFICIAL INSPECTION FO —NOT FOR VOLUNTARY ASSESSMENTS I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:V 7 A n n t.= g S2
_d1!o =�i, � o o•�c�C.
Owner: Cb v ra9er Re lor• {�a►�
Date of Inspection:
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or`Sno"to each of the following for all inspections:
Yes No
_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
-IC Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged.SAS or cesspool
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
® _V"Liquid depth in cesspool is less than 6"below invert or available volume is less than''/a day flow
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
® Any portion of the SAS,cesspool or privy is below high ground water elevation.
Any,portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
✓Any portion of a cesspool or privy is within a Zane 1 of a public well.
_ e .Any portion of a cesspool or privy is within 50 feet of a private water supply well.
V1 Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the well water analysis,
performed at a DEP.certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
9trogen and nitrate nitrogen.is equal to or less than 5 ppm,provided that no other failure criteria
are triggered.A copy of the analysis must be attached to this form.]
(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd•
You must indicate either"yes"or`no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
the system is within 400 feet of a surface drinking water supply
_ the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes"in Section D above the large system has failed.The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304.The system owner should contact the appropriate regional office of the Department.
1
Page 5 of 11 .
OFFICIAL INSPECTION FORM®NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 31 A n n E A y
Al o Oi-n-( i✓ o�GC_
Owners r!�,w►�,.�r�.•�%�, Qe i.oc��''a✓t
Date of Inspeetion: __{�!
Check if the following have been done.You must indicate"yes"or"no"as to each of the following:
Yes No
® Pumping information was provided by the owner,occupant,or Board of Health
Were any of the system components pumped out in the previous two weeks?
® � Has the system received normal flows in the previous two week period?
® Have large volumes of water been introduced to the system recently or as part of this inspection 7
® Were as built plans of the system obtained and examined?(If they were not available note as N/A)
® Was the facility or dwelling inspected for signs of sewage back up?
1 Was the site inspected for signs of break out?
Were all system components,excluding the SAS, located on site?
_ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of the baffles br tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum?
d _ Was the facility.owner(and occupants if different from owner)provided with information on the proper
amtanance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes no
Existing information.For example,a plan at the Board of Health.
�( Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable) [3 10 CMR 15.302(3)(b))
P'
Page 6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM,INFORMATION
Property Address: :37 /fit Ah E ra
Owners t t ec, 0^
Date.of Inspections A41 a l
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): Number of bedrooms(actual):
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):
Number of current residents: 14 0 r` 5'
Does residence have a garbage grinder(yes or no):
Is laundry on a separate sewage system(yes or no): WD [if yes separate inspection required]
Laundry system inspected(yes or no):=
Seasonal use:(yes or no); rf�t
Water meter readings,if available'last 2 years usage(gpd)): y j A
Sump pump(yes or no): &
Last date of occupancy:
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15203): gpd;
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):_
Industrial waste holding tank present(yes or no):_
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: ) bw N
Was system pumped as part of the inspection(yes or no):Ato
If yes,volume pumped: gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
Septic tank,distribution box,soil absorption system
_Single cesspool
_Overflow cesspool
—
Privy
_Shared system(yes or no)(if yes,attach previous inspection records,if any)
_Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
_Tight tank _Attach a copy of the DEP approval
_Other(describe):
Approximate age of all components,date installed(if known)and source of information:
Were sewage odors detected when arriving at the site(yes or no): 6Lp
i r�
i fy
Page 7 of I I i�s
r .h
OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS j
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: A vx A j (x v
urn
Owner: e— 'Ch. Reloe"- �cy-
Date of Inspection: V
BUILDING SEWER(locate on site plan)
Depth below grade: 24"
Materials of construction: cast iron 40 PVC_other(explain):
Distance from private water supply well or suction line: AIA
Comments(on condition of joints,venting,evidence of leakage,etc.):
�, �,- d►�. r,ar QASE� -T Gb c>t nsAT� Llk)es -S did S>
SEPTIC TANK:_(locate on site plan)
Depth below grade: 15
Material of construction: concrete metal_fiberglass_polyethylene
_other(explain)
If tank is metal list age: 'ls�age'confirmed by a Certificate of Compliance(yes or no):a(attach a copy of
certificate)
Dimensions: 1.'S oo GA L Lows
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from'.bottom of scum to bottom of outlet tee or baffle:
How were dimensions determined:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
T'iF).l)4k %t j 'b V, �tJ s7 1�.CL4> M E h1 J1 N S T,l�L L 0}--n U N (—
(2,i5c-125 y L I hJ�N
FiN�s(.f
GREASE TRAPgWocate on site plan)
Depth below grade:_
Material of construction:_concrete_metal_fiberglass polyethylene_other
(explain):
Dimensions'
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
i
Page 8 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C '
SYSTEM INFORMATION(continued)
Property Address: A o N f i?-)
_ _
Owner: R.e la ,�:;�
Date of Inspection: , p
TIGHT or HOLDING TANK:ALL(tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass_polyethylene other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBU'T'ION BOX: (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: L
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.):
6---A ', k b:r= w A-ri t2
PUMP CHAA11BER:ALI*�,_(locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
V.,
Page 9 of I I
OFFICIAL INSPECTION FORM o NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 3 7 A,
NQ 11T_X{
Owner: 22mnnQnwec,
Date of Inspection:__k L of
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number:_
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions: L t-r► a 0 3 0
overflow cesspool,number:
innovative/alternative system Typetname of technology:
Comments(note condition of soil,signs of hydraulic failure,level of pending,damp soil,condition of vegetation,
etc.):
rR.�A or— t°t61.k7 t-5O>A5 IVDaAt /dL
CESSPOOLS:41',& (cesspool must be pumped as part of inspectionXlocate on site plan)
Number and configuration:
Depth—top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments(note condition of soil,signs of hydraulic failure,level of pending,condition of vegetation,etc.):
PRIVY:_Ll/&(locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
Page 10 of 11
OFFICIAL INSPECTION FO ®NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL. SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: Q e
Owner: vtc�eo.l�hly eat
Date of Inspection: to ! ow
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building.
JAL-> PIT IQ
r
VIP '���
Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 31 9.2
Owner:
Date of Inspection:- (el %9101
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain:
Checked with local excavators,installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
AJ All?-Q- D CM ht o D LET 1'am j E(7
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NEW ENGLAND ENGINEERING SERVICES INC.
60 BEECHWOOD DRIVE,NORTH ANDOVER, MA 01845
PHONE 978-686-1768 FAX 978-685-1099
i
FAX MEMO
DATE: 6/19/01
To: Doug Pratt
FROM: Ben Osgood Jr.
I
This transmission contains 12 pages including this cover'sheet.
If this transmission is unclear or you experience difficulties you may call at
978-686-1768.
Message:
Thank You
Ben 0,5good
New England Engineering
60 Beechwood Drive, North Andover
Phone: 978-686-1768 or 888-359-7645
Fax: 97876.85-1099
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_6ystem Il r "In Record
System Omier System Location
v
Date of Pumping: °° Quai►tity Pumped: l gallons
Cesspool: No Ves L..l Septic Tauk: No Yes
System Pumped by: Felredea 60"W4 License#
Contents transferrred to : Greater Lawrence,9enitary District
Date: _---- _ Inspectors
commonwealth of Massachusetts
� , Massachusetts
1
��te burn iig Record
System Owner System Location
Date of Pumping: ) /u Quaittily Pumped: ob gallons
Cesspool: No CV J Yes U Septic Tank: No U Yes
Systent Pumped by: Faredart ifla,� 'lided License#
Contents transferrred to : Greater Lawrence Sanitary District —
Date: Inspector:
� i3CY'dd7'F1.q
TOWN OF NORTH ANDOVER
HEALTH EPA T ENT
27 CHARLES STREET w
NORTH ANDOVER MASSACHUSETTS 01845 �q°°pnreo M�RRS
ANDOVER, CMUSE
Sai).dra Starr Telephone(978) 688-9540
Public Health Director FAX(978)688-9542
June 26, 2001
RE: Letter of Noncompliance -Notice of Septic System Failure at
37 Anne Road,North Andover, MA 01845
To Whom It May Concern:
The North Andover Health Department has received and reviewed the Title 5 Inspection Report
that was generated from the inspection of the septic system at 37 Anne Road,North Andover,
MA on June 14, 2001. Your inspector has determined that your septic system is failing to protect
public health or the environment according to Title 5 of the State Sanitary Code. You are hereby
required to retain the services of a Massachusetts licensed professional engineer(P.E.) or
Massachusetts registered sanitarian(R.S.) to design a new septic system in compliance with Title
5 and North Andover Board of Health regulations. Please be advised that you have two years
from the date of the inspection to complete the necessary upgrade work. However,please be
aware that if the dwelling at this location is currently vacant, it may not be re-occupied until the
septic system has been repaired or the site connected to municipal sewer.
It is recommended that you hire a septic hauler to periodically pump your septic tank until such
time as a repair can be completed.
The Board thanks you for your willingness to help protect the environment, the ground water and
public health. Please do not hesitate to call the Health Department office at the number above if
you have any questions.
Sincerely,
Sandra Starr, R.S., C.H.O.
Health Director
Encl. P.E. list
Hauler list
Brochure
Cc: File
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